The year 2013 closed with considerable public focus on extreme fitness activities. Obstacle courses, fitness races and almost cultlike fitness activities have garnered ever increasing public interest and fitness industry market share. However, at the same time, these events have heightened public and media focus on fitness activity injuries and deaths as well as the qualifications of fitness professionals such as personal trainers.

RISING INJURIES AND DEATHS DURING FITNESS ACTIVITIES

Media articles about fitness-related injuries and deaths are replete with stories highlighting the problems with some recent fitness and sports type activities.(1) The New York Times reported on the subject on March 31, 2014 in “With Thrills Come Extreme Risks.”(2) Men’s Health, in a June 2012 article, reported on “America’s Scariest Fitness Trends,”(3) while the Baltimore Sun in 2013 reported on “Death and injuries at events like Tough Mudder and Warrior Dash lead to Lawsuits.”(4) Even Huffington Post Healthy Living carried a similar story in 2013 entitled, “How Dangerous are Tough Mudders?”(5) Sadler Sports and Recreation Insurance reports that “Thousands [are] Injured in Gyms and at Home in Pursuit of Fitness.”6 To be sure, these stories, as well as the injuries related to incidents occurring in gyms or associated with exercise equipment use, demonstrate the issue.(7)

Older adults engage in a variety of recreational activities. Exercise (including walking, equipment use, and exercise classes), bicycling, snow skiing, golf and fishing were responsible for the majority of recreational injuries. These injuries ranged from serious, those associated with significant morbidity and mortality (for example, fractures), to minor, those that merely required a little medical attention (for example, a fishhook in a finger). While many injuries to older adults who are treated in emergency departments may appear to be minor, some may have important long-term consequences. Such injuries can seriously affect an older person’s ability to function independently. Shapiro8 and co-workers followed a group of persons > 65 years who were treated in emergency departments for minor injuries (including 26% fracture). Seven percent of them had decreased scores in fundamental activities of daily living and 23% had decreased scores in instrumental activities of daily living. Shapiro described the epidemiology of recreational injuries among older adults treated in emergency departments. They were injured while participating in a wide variety of recreational activities, particularly while bicycling and exercising. Fractures were common and women were more likely than men to suffer fractures. Many injuries are potentially preventable. As more persons engage in recreational activities, applying known injury prevention strategies will help to reduce the incidence of these injuries.

Accidents, poor training practices, improper supervision and other factors can all affect the type, severity and rate of injuries. The popularity of personal trainers is on the rise, likely due, at least in substantial part, to countless aging baby boomers feeling the need to start exercising the “right way” and to stay fit. Along with that increase however, is a rise in injuries sustained at the gym. The prevalence of related injuries increased according to a study conducted by the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.(9) The researchers discovered that U.S. hospital emergency departments treated more than 970,000 injuries related to weight training between 1990 and 2007. These rates demonstrated an almost 50% increase during that 18-year period.

ADDRESSING THE PROBLEM OF FITNESS PROFESSIONAL COMPETENCE

While the International Health, Racquet & Sportsclub Association (IHRSA) attempted to address the problem of fitness professional competence in 2003 by recommending that fitness professional certification procedures and protocols be accredited by the National Commission for Certifying Agencies (NCCA), the number of injuries reported by the media and the U.S. Consumer Product Safety Commission have not diminished since then. Some organizations such as the American College of Sports Medicine (ACSM), the American Council on Exercise (ACE) and others opted for this accreditation alternative. However, in 2006, IHRSA amended its 2003 resolution and thereby noted the importance of education in the certification process. IHRSA then recommended to its member clubs that other, equivalent accrediting organizations also be recognized for fitness professional certifiers contingent upon their recognition by the United States Department of Education (USDE) and/or the Council for Higher Education Accreditation (CHEA). Organizations such as the Aerobics and Fitness Association of America (AFAA) chose to have their certification programs accredited by this method. The Distance Education and Training Council (DETC) was approved for this role by IHRSA in 2006 and AFAA and others such as the International Sports Sciences Association (ISSA) then became accredited by the DETC.

The certification recommendations made by IHRSA to first just embrace NCCA accreditation were seemingly made to assure the public of the competence of fitness professionals and to reduce the rate of relevant injuries. However, the rate of injuries continues to be a problem. As a consequence, many consumers and media representatives began asking once again as they did in the early 2000s,(10) “Who are these so-called fitness professionals and what is their education and training?”

PRACTICAL TESTING SHOULD BE A REQUIREMENT

Unfortunately, some of the answers that the public and the media are getting reflect rather poorly on these issues. While the accredited fitness professional certification industry conducts written multiple-choice type tests for personal trainers prior to their certification, the only prerequisites for testing as established by most NCCA accredited fitness professional certifiers are that applicants be 18 years of age, high school graduates (or the equivalent)(11) and have completed a hands-on certification in cardiopulmonary resuscitation (CPR). No other specific educational prerequisites are required of those so certified by NCCA accredited certifiers and no hands-on, practical competency testing takes place at all as part of their certification testing process, even though NCCA standards allow for such practical assessment testing. Why? Applicants for NCCA accredited certification programs for orthotics and prosthetics, crane operators and even chefs have to demonstrate their skills through a practical testing component because the written certification exam for these classifications has been deemed to be not sufficient. Why not have such a practical testing component for personal trainers? Why not require educational prerequisites to sit for a certification examination? What insurmountable barrier is there for NCCA accredited fitness professional certification programs to evaluate practical personal training performance?

Some may ask, “How can this be? Shouldn’t hands-on experience be required of all professionals who serve the public?” For example, who would pick a physician to perform a surgical procedure with no medical degree or one without hands-on experience in the operating room? In light of this kind of deficiency, how are fitness professionals certified by NCCA accreditors to gain acceptance into the healthcare profession as many fitness professionals are now advocating, if there is no requirement for education and practical hands-on competency testing in addition to just a written, multiple-choice test with no really important educational prerequisites and no hands-on practical experience or testing of any kind?

The question then arises as to why many in the fitness profession are so against practical competency assessment. In fact, some of those organizations that are currently accredited by the NCCA claim that their written certification exam tests how professionals use their knowledge in a practical setting. In addition, they also claim that practical testing and psychometric best practices on competency assessment leave too much room for error and subjectivity. This is difficult to understand given the fact that all of the health professions, other than fitness industry professionals, must demonstrate practical competence as part of their rise to certification and doing so is indeed considered a best practice. Health professionals go further in most situations to licensure where clinical/practical competency is also tested to ensure the safety of the public.

Parameters as to what practical competency should consist of are needed in the fitness industry and there is a lack of research to determine a correlation between participation in continuing education and improved practice outcomes. Because of this many have turned to certification as an indicator of entry-level competence. This type of certification is considered a regulatory requirement. Certification in these instances is therefore not a voluntary process, but instead constitutes a regulatory requirement to ensure public safety and enhance public health. As a result, certifying bodies are expected to demonstrate that their initial certification exams truly reflect entry-level competence and that their recertification process reflects continuing competence.

A number of reasons have been put forth as to why no hands-on, required competency assessments are included in NCCA accredited fitness certification examinations. ACE has stated, among other things, that practical testing adds “a great burden for candidates in terms of time and unfamiliarity with the format.”(12) Others have stated that a practical testing component cannot be fair and unbiased and that adding a practical component to a certification exam would be too costly.(13 )Despite such comments, practical hands-on testing/learning of some fashion is part of nearly all healthcare providers’ educational/training/testing programs including those who eventually sit for an NCCA accredited certification examination.(14) Why then, especially under circumstances where fitness professionals wish to join the ranks of healthcare providers, is there no hands-on education, training or testing component to the NCCA accredited fitness professional certifications?

In 2007, with revisions in 2013, a number of groups, including four fitness professional certification organizations (ACSM, ACE, NASM and The Cooper Institute), all of which have also had their personal trainer examinations accredited by NCCA, wrote, adopted and published Standards and Guidelines for the Accreditation of Educational Programs in Personal Fitness Training (Standards)(15) along with the Commission on Accreditation of Allied Health Education Programs (CAAHEP). These Standards for the development, evaluation and self-analysis of personal fitness training programs, clearly state that post-secondary institutions offering educational programs for personal fitness trainers must be accredited by an accrediting agency that is recognized by the U.S. Department of Education. According to these Standards, the curriculum for such programs must include at a minimum, a clinical component—a supervised internship experience. A published “benefit” for a student attending such an accredited program includes the alleged ability to sit for a certification or licensure examination.16 However, none of the foregoing four fitness professional certifiers that participated in drafting these Standards are accredited by an institution recognized by the U.S. Department of Education; none require any kind of post-secondary educational program to sit for any of their NCCA accredited personal fitness trainer certification examinations;(17) and none of the four have any hands-on, practical component to those same certification examinations. Why, one may ask, especially when these four organizations participated in writing and establishing these Standards, have they ignored their own Standards? For whose benefit?

Why do some of the NCCA accredited fitness professional certifiers require as part of the foregoing Standards a specific curriculum but don’t mandate those same courses in order for someone to take their certification examinations? Why do those Standards include a practical component requirement while the NCCA accredited fitness professional certifiers do not require a hands-on component for their certification examinations or even as a prerequisite thereto, except for CPR?

Some industry certification exams are accredited by NCCA. The personal training profession falls within the Fitness and Wellness certification category of the NCCA system. There currently are 14 organizations whose certification examinations are certified with NCCA for fitness professionals. There are many other healthcare organizations that accredit their certification examinations through the NCCA. In cases where there is a practical component to the profession, there are some clinical or practical methods for determining practical competence before applicants complete their education or training and are eligible to sit for a certification exam. That is true for every profession except for fitness professionals. There is simply no requirement for the hands-on demonstration of practical skills for this professional category by NCCA accredited fitness professional certifiers other than through the written certification examination.

Anthony A. Abbott, EdD, a prominent exercise physiologist who has testified in numerous litigations in large part dealing with the qualifications of personal trainers has stated:

…just because one is certified does not necessarily equate with his or her being qualified. To become a truly qualified personal trainer requires an in-depth knowledge of anatomy, physiology, kinesiology, biomechanics and principles of exercise science coupled with considerable hands- on training.(20)

Most individuals that become CPTs prepare for the certification exams by reading recommended resources, attending workshops, or participating in online programs. It is the opinion of this commentator that this is not nearly enough. Formal education along with supervised practical experience is needed to prepare personal trainers for all tasks they perform, not just fitness testing. Currently, none of the NCCA accredited certifying organizations require completion of any formal education or evaluation of practical skills prior to sitting for their CPT exams. In addition, none of the 21 standards in the NCCA’s Standards for the Accreditation of Certification Programs require candidates to possess any formal education or practical experience prior to sitting for an NCCA accredited exam.(22)

DUAL ACCREDITATION IS THE ANSWER

Fortunately, there are a number of non-NCCA accredited fitness professional certification organizations that are placing emphasis on education for fitness professionals in addition to mere testing. At least one organization, AFAA, is also providing real-time, hands-on practical testing of those individuals who seek personal trainer and group exercise certification. AFAA’s distance education programs for personal training and group exercise instruction are accredited not by the NCCA, but by the DETC, which accredits institutions and their educational programs.

DETC accredited entities provide for specific educational programs. In this regard, with a DETC accredited entity, the public might then know that its programs are educationally based before any certification may be later awarded to a fitness professional. Moreover, with an organization such as AFAA, the public will also know that AFAA personal trainers have been tested for hands-on performance as part of its examination process. AFAA’s certification examinations for personal trainers and group exercise instructors, including its practical testing components, have been accredited for many years by Vital Research of Los Angeles. Isn’t such an integrated educational program followed by practical examination and testing for fitness professional certifications all- encompassing so that consumers may be satisfied with the quality of those personal trainers providing service to them? Wouldn’t certification, with a prerequisite for an educational requirement, practical testing and an examination, be the thing that truly unlocks the door for fitness professional entry into the healthcare industry? Isn’t that what those already in the healthcare industry require of themselves? Shouldn’t that form of accreditation be required of all United States fitness professional certification organizations? Why isn’t the industry demanding that such credentialing be required? Why does AFAA stand alone in the United States with such a dual accreditation for its fitness professional programs in personal training and group exercise?

Physicians who are at the top of the healthcare field are required to complete high school, undergraduate studies, medical school, including pre-clinical and clinical parts, and then engage in further training, pass a state administered license examination before practicing on their own and, in some cases, complete a residency and internship program. Specialization can follow. All steps for physicians after college graduation involve practical training.

Registered nurses are required to secure an undergraduate degree in nursing, or at least a two-year degree for a defined technical scope of nursing practice including extensive clinical training and passage of a board examination.

Physical therapists are required to attain an undergraduate degree, then earn an advanced degree with substantial clinical requirements and pass a national examination usually followed by a residency.

While practical components of a certification examination or prerequisites to certification testing can be challenged on the basis of arbitrariness, unfairness, bias or discrimination, such testing methods or prerequisites are not per se impermissible, nor have they been extensively attacked especially in professions such as those in healthcare.

Education, practical training and testing are all nearly universal requirements for the foregoing healthcare professionals. Other healthcare professionals often have similar paths to follow even if they are in assisting roles to the foregoing professionals. In fact, almost all NCCA accredited organizations providing certification for numerous allied healthcare professions require some form of practical, hands-on training before certification examinations are completed.23 If personal trainers really want to enter the health- care profession, shouldn’t specific prerequisites for education and practical, hands-on training and testing be required of them? Isn’t it time for the fitness industry to require all three components as part of every fitness professional certification process and a dual accreditation requirement—one for education and one for testing with practical training or practical testing?

If the fitness industry doesn’t take steps to improve the certification process, it will become more likely that governmental agencies will step in to protect the public through a regulatory process they determine and establish. Efforts to do so have already been put forth with some regularity and frequency.24 The first effort passed in the District of Columbia in February of 2014.25

It’s time for a change in the fitness industry. Accreditation of fitness professional educational programs followed by practical training/testing together with written and accredited certification examinations should be required of all United States fitness certification organizations.

It is time for all United States fitness professional certifiers to step up and have dual accreditations for their fitness professional educational programs as well as their examination-based certification programs. Such accreditations must include educational program requirements as a prerequisite before examination, including testing and evaluation of hands-on competencies by qualified personal trainers. Only one fitness professional certifier, AFAA, has accredited its personal trainer and group exercise instructor educational programs by an entity such as DETC and also accredited its written and hands-on testing examinations through Vital Research. More needs to be done by other such certifiers. AF

IHRSA, THE INTERNATIONAL HEALTH, RACQUET & SPORTSCLUB ASSOCIATION BEGAN ITS EFFORT TO RECOMMEND TO ITS MEMBER CLUBS THE ACCREDITATION OF PERSONAL TRAINER CERTIFICATION ORGANIZATIONS IN 2002 AFTER A PERIOD OF RATHER INTENSE MEDIA SCRUTINY OF FITNESS PROFESSIONALS DUE TO A NUMBER OF INJURIES AND DEATHS IN SOME FITNESS PROGRAMS.

SOME NCCA ACCREDITED CERTIFIERS DON’T EVEN REQUIRE THAT THE EXAMINEE BE A HIGH SCHOOL GRADUATE, SEE, E.G., THE COOPER INSTITUTE, CI-CERTIFIED PERSONAL TRAINER (CI-CPT) CANDIDATE GUIDE, HTTP://WWW.COOPERINSTITUTE.ORG/VAULT/2440/ WEB/FILES/663.PDF.

IN COOPERATION WITH THE COMMISSION ON AC- CREDITATION OF ALLIED HEALTH EDUCATION PROGRAMS (CAAHEP) AND THE COMMITTEE ON AC- CREDITATION FOR THE EXERCISE SCIENCES (COAES), ACSM, ACE, THE COOPER INSTITUTE AND NASM, ALL NCCA ACCREDITED FITNESS PROFESSIONAL CERTIFIERS, ALONG WITH OTHER ORGANIZATIONS, DEVELOPED STANDARDS AND GUIDELINES FOR THE ACCREDITATION OF EDUCATIONAL PROGRAMS IN PERSONAL TRAINING IN 2007 AND REVISED THAT STANDARD IN 2013. THOSE ACCREDITATION STANDARDS STATE THEY ARE “THE MINIMUM STANDARDS OF QUALITY USED IN ACCREDITING PROGRAMS THAT PREPARE IN- DIVIDUALS TO ENTER THE PERSONAL FITNESS TRAINING PROFESSION.” THE STANDARDS REQUIRE SPECIFIC CURRICULUM, INCLUDING A “SUPERVISED INTERNSHIP EXPERIENCE”. IF THESE STANDARDS PROVIDE FOR A CURRICULUM AND A PRACTICAL COMPONENT, WHY ARE THEY NOT PREREQUISITES TO SIT FOR A CERTIFICATION EXAMINATION AS THAT “BENEFIT” IS PUBLISHED FOR THE CERTIFICATION?

AFAA is in the process of completing the construction of its own web site/directory that is in conjunction with The Biggest Loser television show. As such, AFAA certified professionals who have been verified by AFAA and choose to become Biggest Loser Pros, will be able to leverage the power of the show and earn fees from AFAA to conduct online sessions with clients. In addition, the Biggest Loser Pros will be authorized to conduct Biggest Loser Live Training sessions at local clubs and change the lives of millions of people who need help to lose weight safely and effectively.

In light of some industry confusion surrounding the certification of fitness professionals, the accreditation of certifying agencies and proposals to license fitness professionals in various states, following is some insight into these issues from a well-known industry lawyer and commentator, David L. Herbert, co-editor of The Exercise Standards and Malpractice Reporter, now in its 25th year of publication. His comments are attached through the following link: http://pdfs.afaa.com/afaa_letter_07-12-11.pdf

AFAA is the world's largest fitness and TeleFitness® educator. Since 1983, AFAA has issued over 300,000 certifications to fitness professionals from more than 73 countries around the world. Each year, health clubs, Universities, military installations and studios host over 2500 educational workshops worldwide. AFAA provides comprehensive written and practical examinations that help to ensure you possess the skills and knowledge necessary for a rewarding career! AFAA is accredited by the Distance Education and Training Council (DETC) which is an organization recognized by the Council for Higher Education Accreditation (CHEA) and the US Department of Education, meeting IHRSA's 2005 recommendation on accreditation for fitness certification organizations. AFAA is also proud to be a member of the Institute for Credentialing Excellence (ICE), and has been granted full status with the National Board of Fitness Examiners (NBFE).